Prediction of risk of calcification of heart valve bioprostheses on the basis of comprehensive assessment of recipients clinical factors and their compliance with therapy

Abstract

Purpose. The development of the prediction methods of calcification risk of heart valve bioprostheses (BP) based on comprehensive assessment of the impact of clinical factors of the recipients and their adherence to medication. Materials and methods. We performed a retrospective study of clinical status and adherence to drug therapy of 170 recipients of heart valve BP with (n=63) and without (n=109) calcification. We used the method of comprehensive assessment of the analyzed parameters with estimation of prognostic coefficients for each of them, followed by calculation of integral indicators and construction on their basis of prognostic models for the various intervals of BP functioning. Results. The most important risk factors of calcium-associated BP dysfunctions at any duration of observation were heart failure decompensation, as well as the discontinuation of ACE inhibitors and β-blockers. At duration of BP functioning up to four years negative effect on prognosis produced the presence of concomitant multifocal atherosclerosis, during additional 4 (from 4 to 8) years - diabetes mellitus, and afterwards (over 8 years) - coronary artery disease. Lowering of probability of BP calcium degeneration was related to regular use of aldosterone antagonists during first 4 years after BP implantation and regular subsequent use of statins. Conclusions. Based on the comprehensive assessment of clinical status of patients and their compliance to medication it is possible to make adequate prediction models for assessment of the risk of structural dysfunctions due to BP calcification at various time intervals of remote postoperative period.